Enter or select the month, date and year from your state formation docs.

State of Formation*

State

Primary NAICS code*

Enter your six (6) digit primary NAICS code.

Please visit the Census Bureau if you do not know your primary NAICS Code. The primary NAICS code is the six digit code in which your business earned its largest segment of revenue in the most recently completed fiscal year.

Dun and Bradstreet number*

Enter your nine (9) digit Dun and Bradstreet number.

Dun and Bradstreet. (DNB). You must have an active DNB profile to get Hubzone Certified. If you do not know what your DNB number is and are registered in this system, please visit this link to lookup your current DNB profile number. Enter N/A if you do not have an active DNB profile.

DS Logon. This is account is needed to submit your VetBiz Application electronically.

Yes

No

Average Number of employees the business had during the last 12 months*

Direct employees (W-2 or owners). Not Subcontractors. Count all owners who participate in the business too.

Current Number of employees the business has*

Direct employees (W-2 or owners). Not Subcontractors.

2018 Sales*

Enter the exact gross receipts reported on your 2018 business tax return or end of year Profit & Loss statement. Do not round.

2017 Sales*

Enter the exact gross receipts reported on your 2017 business tax return. Do not round.

2016 Sales*

Enter the exact gross receipts reported on your 2016 business tax return. Do not round.

How many owners, officers, directors, partners, LLC members or key employees does the business have?*

1

2

3

4 or more

Since you have more than 4 individuals, please contact us and we will email you a questionnaire to complete offline.

Names of all owners, officers, directors, partners, LLC members and key employees of the business.

Anyone who is an owner, officer, director, partner, LLC member or key employee of the business must listed in your VA VetBiz Application. Key employee is defined as any individual with “critical influence or or substantial control over the operations or management” of the company. (e.g. has the authority to engage in decision making on behalf of the company.)

Individual #1 - Name*

FirstLast

Percentage of ownership for Individual #1*

Enter a number between 0 and 100.

Title of Individual #1*

President

CEO

Vice President

Managing Member

Member

Director

Secretary

Treasurer

CFO

CTO

COO

Other

Individual #1 - Does this individual work full-time in the business without any outside employment?*

Yes

No

US Citizenship for Individual #1*

Yes

No

Individual #1 - Is this individual a Veteran or Service Disabled Veteran?*

Yes

No

Enter the Information for Individual #2 below:

Individual #2 - Name*

FirstLast

Percentage of ownership for Individual #2*

Enter a number between 0 and 100.

Title of Individual #2*

President

CEO

Vice President

Managing Member

Member

Director

Secretary

Treasurer

CFO

CTO

COO

Other

Individual #2 - Does this individual work full-time in the business without any outside employment?*

Yes

No

US Citizenship for Individual #2*

Yes

No

Individual #2 - Is this individual a Veteran or Service Disabled Veteran?*

Yes

No

Enter the Information for Individual #3 below:

Individual #3 - Name*

FirstLast

Percentage of ownership for Individual #3*

Enter a number between 0 and 100.

Title of Individual #3*

President

CEO

Vice President

Managing Member

Member

Director

Secretary

Treasurer

CFO

CTO

COO

Other

Individual #3 - Does this individual work full-time in the business without any outside employment?*

Yes

No

US Citizenship for Individual #3*

Yes

No

Individual #3 - Is this individual a Veteran or Service Disabled Veteran?*

Yes

No

All Other Business Information:

Is the business owned at least 51% by another entity, trust, ESOP or 401(k)?*

Yes

No

Is the business part of a franchise?*

Yes

No

Is the business involved in a Mentor/Protege Agreement?*

Yes

No

Do one (1) or more Veterans unconditionally own at least 51% of each class of member interest?*

Yes

No

Are one (1) or more Veterans entitled to receive at least 51% of the annual distributions of profits paid to the owners?*

Yes

No

Do one (1) or more Veterans control the day-to-day operations of the business?*

Do one (1) or more Veterans have the managerial experience of the extent and complexity needed to run the business?*

Yes

No

Do one (1) or more Veterans possess the technical expertise and hold the required licence(s)?*

Yes

No

Do one (1) or more veterans devote full-time to the business during the normal working hours of firms in the same or similar line of business?*

Yes

No

Are one (1) or more veterans engaged in employment or management outside the applicant business?*

Yes

No

Does a veteran hold the highest officer position in the business as established by the applicants governing documents?*

Yes

No

Do one (1) or more veterans serve as management members with control over all decisions of the company?*

Yes

No

Did a non-veteran transfer majority stock ownership or control of the firm to an immediate family member within 2 years prior to the application?*

Yes

No

Is a Veteran the highest compensated individual in the business?*

Yes

No

Does a non-veteran or entity provide financial support or possess a required license?*

Yes

No

Does a business relationship exist with one (1) or more non-veteran or outside entities?*

Yes

No

Other than any publicly traded stock, bonds, and mutual funds owned, does any individual you identified have an ownership interest in any other business, and/or are they an officer or director in any other business concern other than the business applying for 8(a) Certification? This includes LLC's for holding real estate.*

Yes

No

ADDITIONAL INFORMATION NEEDED: Since you indicated that an individual you identified has ownership in another business other than the business that is applying for the Hubzone Program, please explain below. Provide the name of the individual you identified above that has ownership interest in another business, the name of the other business and a brief description of what the other business does. Once we know the specifics we will let you know if this will be an issue.

Since you answered YES, please explain below:*

Has any individual you identified ever been debarred, suspended, voluntarily excluded or otherwise the subject of an action that rendered them ineligible for procurement or non-procurement purposes from any department or agency of the Federal Government?*

Yes

No

ADDITIONAL INFORMATION NEEDED/POTENTIAL ELIGIBILITY ISSUE: Since you indicated that an individual you identified has been debarred, suspended, voluntarily excluded or otherwise a subject of an action that rendered then ineligible for procurement or non-procurement from any department or agency of the Federal government, please explain below. Include the individuals name and what occurred.

If an applicant or one of the individuals you identified is currently debarred, suspended or voluntarily excluded the firm is ineligible for the Hubzone Program.

Since you answered YES, please explain below:*

Does the business have any existing management, joint venture, teaming, Indemnity, outside consulting, distributorship, licensing, trust or franchise agreements?*

Yes

No

ADDITIONAL INFORMATION NEED: Since you indicated that your business has existing management, joint venture, teaming, indemnity, outside consulting, distributorship, licensing, trust or franchise agreements the SBA will want to examine these to see if there is any potential for affiliation or control issues. Please provide the details below. If you just have normal contractual or sub contractual agreements please answer "No" to this question.

Since you answered YES, please explain below:*

Does the business have any ownership interest in, or an affiliation with any other business concern?*

Yes

No

ADDITIONAL INFORMATION NEEDED: Since you indicated that business has ownership in, or an affiliation with another business concern, please provide the details below. Once we know the specifics we will let you know if this may be an issue.

Since you answered YES, please explain below:*

Does any other business or other organization have an ownership interest in the business concern?*

Yes

No

ADDITIONAL INFORMATION NEEDED/POTENTIAL ELIGIBILITY ISSUE: Since you indicated that another business has ownership in your business concern, please provide the details below. This may be an eligibility issue. Once we know the specifics we will let you know.

Since you answered YES, please explain below:*

Does (or do) any outside entity (ies) or individual(s) other than the Applicant(s) provide financial or bonding support, licenses or required professional certification, office space or equipment to the applicant business?*

Yes

No

POTENTIAL ELIGIBILITY ISSUE: Since an individual you identified, other than an Hubzone Applicant, provides financial or bonding support, licenses or required professional certification, office space or equipment to the business, please provide the details below. This may be an eligibility issue. Once we know the specifics we will let you know.

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